Healthcare Provider Details

I. General information

NPI: 1598436057
Provider Name (Legal Business Name): KYRA MARIE FORTE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2021
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 COLUMBUS CIRCLE FL 8
NEW YORK NY
10019-1412
US

IV. Provider business mailing address

435 E 70TH ST APT 6J
NEW YORK NY
10021-5340
US

V. Phone/Fax

Practice location:
  • Phone: 212-664-9323
  • Fax:
Mailing address:
  • Phone: 551-265-6969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number027301
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: